Wednesday, August 16, 2006

Latex in Modern Life

The AIDS thing is well underway. Bill Gates is coming across as the 'funder of the fight'. Bill Clinton, a devotee of hi-risk sexual behaviour, has upstaged Stephen Lewis as the AIDS international spokesperson. And the theme, 'Time to Deliver', is played up big - throw a lot of money at it and we can 'defeat' AIDS by 2021, says Bill Gates.

The focus this year should be on sex-trade workers. There is no secret that prostitutes and their clients, are largely affected and are vectors of the disease in many areas of the world. Bill Clinton wants to ensure that hookers everywhere have access to condoms and use them. He thinks this is do-able and most people seem to share his opinion. Perhaps a good coating of teflon might help.

Prostitutes and their clients, while part of life in many places, are virtually non-existent in others - it all depends on what behaviours are tolerated. Some behaviours, because of AIDS, are the equivalent of a bullet, and should not be tolerated, let alone promoted. The opportunities for error due to lack of control are simply too great.

In like manner, circumcision, is being touted as a possible panacea. What the third world needs is a cheap bris - foresight with foreskins! This as a result of a study indicating that AIDS is notably less-prevalent in northern African countries where circumcision (both genders?) is practiced. It might have escaped the students that the prevalent Moslem religion, which takes a dim view of AIDS-inducing behaviours, might have as much to do with that. Once again let's not talk about behaviour, when we can actually 'do' something!

What gets me is the poo-pooing that goes on about the ABC approach to Aids - an educative process aimed at the young which emphasizes chastity, faithfulness and monogamy. While successful in some countries (eg Kenya), those who work in the AIDS field, particularly in North America, feel that behaviour is a poor place to start controlling AIDS. Which makes me wonder, because behaviour has 88 percent to do with acquiring AIDS.

Prophylaxis - condoms, and now biocide (not virocide?) creams - have "reduced" the transmission rate to only 15 percent a year in Canada. Somehow, I don't think that many new cases a year is anything to be proud about. Given what we know about AIDS in Canada, and how we treat AIDS, either sombody's not taking medication as they should, or we're missing something. AIDS is going to kill you eventually, antiretrovirals into account, and unless there is some behaviour change, there is still a large margin for dumping viral loads into other people, or into things like the blood supply. As I see it, it's that first two or three symptom-free years that are the dangerous time - pills can't touch that, condoms might, better behaviour will. Yes, use condoms, but unless people change, you're going to need some form of immunization to stop AIDS - and that is nowhere on the horizon. Right now, I think education seems to be the best choice, better behaviour the only guarantee, anything else is risk, a risk that still too many take, the effects of which can beggar us all.

As far as Africa is concerned, the situation has gone too far, in many places, to be turned-around. Consistent delivery of anti-retrovirals - even in one-a-week or one-a-month form - if there were such a thing - is problematic in most areas where infection is rampant. Resources might better be used to ensure that the AIDS-free population, and uninfected orphans, have better access to education and the basic resources for life - they may be able to effect change. For the infected, home-grown palliative care, even euthanasia and decent burials might be the best way to go.

There is a tremendous groundswell of support and funding for AIDS 'industry' - more so than for other more prevalent diseases. But AIDS is no 'romantic' way to go - it reduces us to our lowest common denominator before it slays us. I don't envy the altruists who work in the field, they are truly akin to Mother Theresa. But there is no cause for celebrating anything about AIDS, especially the behaviours that transmit it.

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